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Oregon Department Of Environmental Quality Previous two years of.maintenance records are available Yes i i'No If you answered"No,"please explain below: * Previous-two yearsof maintenance:records are attached to this form L j Yes 1 No If you answered"No,"pleaseexplainbelow: * Additional Comments:: 8. Please attach a copy'of the following items:to this form. Contact the DEQ,or the local.Health Department to locate these items, * Theseptic system permit(s)to this form,if available * Theas-built drawing(s)to this form,'ifavailable The Certificate of Satisfactory.Completion to thisform,if available * Additional Comments: 9. Provide=a Plot Plan • Please provide:a sketch of the complete system(show only system components that"were;evaluated) on page 8 of this form,if a copy ofthe original"as-built"drawing is not available. * Please providesketch of the.complete'system on'page 8 of this form iflthe.original "as-built" drawing'is not accurate:or representative of the existing system. * If the Original"as-built drawing,is available'for copy,and the original appears to be accurate and representative of the existing system,write."see attached:as-built"on.page 8 of this form, redrawing the system,is unnecessary. * Additional Comments:. 10: Disclaimer:. This evaluation report describes the septic system as it exists On the date of evaluation and.to the extent that components and operation of the system.are reasonably'observable. DEQ, that this:evaluation report does not;provide assurance or any warranty that the system will operate properly in the future. 11. I hereby certify;by my signature,that the above information and the plot plan on the next page of this form are accurate and true to the best of my knowledge. 4/22/2019, EDWIN"ELLIOTT&:CHRIS RHODA;BACK Date, Signature ofQualified Septic System Evaluator Page 7 of 8